Use of Dexmedetomidine and Opioids as the Primary Anesthetic in Infants and Young Children: A Retrospective Cohort Study.
Anesthetic regimens using dexmedetomidine and short acting opioids have been suggested as potential alternatives to sevoflurane-based anesthesia in children. The primary aim of this study is to compare demographics, intraoperative characteristics, and complications of general anesthetics in which dexmedetomidine and opioids were used without sevoflurane, or in combination with a low sevoflurane concentration, in children 36 months old and younger. The secondary aim is to evaluate intraoperative bispectral index (BIS) values when available in these patients.General anesthetics performed between January 1, 2017 and May 1, 2018 in children 2 years and younger who received dexmedetomidine and remifentanil, with or without sevoflurane, were identified. Additional anesthetics performed during this time in children 36 months and younger who received dexmedetomidine and opioids and had BIS monitoring were also identified. Charts were reviewed for demographic and intraoperative variables, including drug administration and hemodynamic data.A total of 244 patients were identified. All but 22 patients received remifentanil. Ninety-two patients received sevoflurane with a mean end-tidal concentration of 0.84 percent (SD 0.43). Compared to the sevoflurane group, the non-sevoflurane group received more remifentanil (median dose 0.4 mcg/kg/min versus 0.2 mcg/kg/min, difference of 0.1 mcg/kg/min, 95% CI 0.1-0.3, p<0.001), more dexmedetomidine (median dose 0.9 mcg/kg/hr versus 0.3 mcg/kg/hr, difference of 0.6 mcg/kg/hr, 95% CI 0.4-0.8, p<0.001), and had a higher mean arterial pressure (median 53 mmHg versus 42 mmHg, difference of 11 mmHg, 95% CI 8.1-14.8, p<0.001). Complications between the two groups were comparable. The median percent intra-operative time with BIS reading less than 60 was 71.6% (95% CI: 63.3%-79.8%).Dexmedetomidine and opioids can effectively be used in young children as an alternative total intravenous anesthesia technique with or without < 1 minimum alveolar concentration of sevoflurane. Bispectral index monitoring reveals a likely sufficient depth of hypnosis.